Videos of Surgical Procedures in Dermatology
Partial Nail Matricectomy with Carbon Dioxide Laser
Matricectomía ungueal parcial con láser de CO2
H.A. Cocunubo-Blanco
, B. González-Sixto, G. Pérez-Paredes, M.Á. Rodríguez-Prieto
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Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain
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Cocunubo-Blanco, B. González-Sixto, G. Pérez-Paredes, M.Á. Rodríguez-Prieto" "autores" => array:4 [ 0 => array:4 [ "nombre" => "H.A." "apellidos" => "Cocunubo-Blanco" "email" => array:1 [ 0 => "hacb27@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "B." "apellidos" => "González-Sixto" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Pérez-Paredes" ] 3 => array:2 [ "nombre" => "M.Á." "apellidos" => "Rodríguez-Prieto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Asistencial Universitario de León, León, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Matricectomía ungueal parcial con láser de CO<span class="elsevierStyleInf">2</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 728 "Ancho" => 951 "Tamanyo" => 90476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Partial nail matricectomy with carbon dioxide laser.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Onychocryptosis is a very common disorder. It carries a high morbidity due to the associated pain and inflammation that interfere with normal daily activities. Its treatment can be conservative, which often does not achieve the desired result, or surgical, which is more effective as it is designed to eliminate the part of nail matrix that produces the ingrowing nail plate.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of the surgical techniques used is partial matricectomy with carbon dioxide (CO<span class="elsevierStyleInf">2</span>) laser, first described in 1980. This technique produces accurate, targeted ablation of the nail matrix.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a middle-aged woman with no past history of interest. She presented longstanding ingrowth of the medial border of the nail of the right great toe. The associated pain limited her mobility and she reported recurrent episodes of inflammation.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Procedure</span><p id="par0015" class="elsevierStylePara elsevierViewall">Antisepsis is performed with 0.5% chlorhexidine.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The toe is anesthetized by nerve block of the digital nerves, which run laterally, with the injection of 2<span class="elsevierStyleHsp" style=""></span>mL of 2% mepivacaine without epinephrine to each side of the toe. The patient is left for 15 to 20<span class="elsevierStyleHsp" style=""></span>minutes for the anesthesia to take effect.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A tourniquet is applied. The nail fold and the ingrown nail plate are then incised using a CO<span class="elsevierStyleInf">2</span> laser in superpulse mode at 5 watts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The incised nail fragment is detached and removed with the aid of artery forceps. The area of the nail matrix and nail bed corresponding to the ingrown nail is photocoagulated with the same laser in continuous mode at 2.5 watts.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Two hemostatic sponges are placed on the surgical wound and covered with mupirocin ointment and a sterile gauze dressing.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, it must not be forgotten to remove the tourniquet.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0045" class="elsevierStylePara elsevierViewall">This technique is indicated for the treatment of nail deformities such as ingrown nail (onychocryptosis), onychogryphosis, pincer nail, and poor nail alignment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0050" class="elsevierStylePara elsevierViewall">Absolute: None.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Relative: Peripheral arterial disease and infections.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Benefits</span><p id="par0060" class="elsevierStylePara elsevierViewall">This is a rapid technique with minimal risks and there is little pain or inflammation. The need for sutures is avoided and the technique can be used in patients with pacemakers and those on anticoagulant therapy.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Complications</span><p id="par0065" class="elsevierStylePara elsevierViewall">The complications include wound infection, recurrence, and permanent nail changes due to a poor technique.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Alternatives</span><p id="par0070" class="elsevierStylePara elsevierViewall">Alternative techniques are lateral matricectomy with/without phenolization,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> lateral matricectomy with electrocoagulation, and en bloc excision of the lateral part of nail plate.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">CO<span class="elsevierStyleInf">2</span> laser has been widely used for the treatment of dermatological conditions, including alterations of the nail unit. Its use in partial matricectomy provides a rapid technique that is easy to perform and has practically no contraindications. Damage to surrounding tissues is minimal, and there is little bleeding or inflammation. In addition, the antiseptic effect of CO<span class="elsevierStyleInf">2</span>-laser photocoagulation reduces the risk of infection, thus favoring healing and early reinitiation of the patient's usual activities.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The rates of recurrence and of the appearance of spicules reported in the literature are below 7%.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> We therefore consider that partial matricectomy with CO<span class="elsevierStyleInf">2</span> laser is a suitable option for the treatment ingrown nail and that it offers good functional and cosmetic results.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Description of the Procedure" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Benefits" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Complications" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Alternatives" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cocunubo-Blanco H, González-Sixto B, Pérez-Paredes G, Rodríguez-Prieto M. Matricectomía ungueal parcial con láser de CO<span class="elsevierStyleInf">2</span>. 2014;105:418–419.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0090" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0055" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 728 "Ancho" => 951 "Tamanyo" => 90476 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Partial nail matricectomy with carbon dioxide laser.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 8322945 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for ingrowing toenails" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.A. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 9 | 22 |
| 2024 Octubre | 100 | 50 | 150 |
| 2024 Septiembre | 123 | 23 | 146 |
| 2024 Agosto | 143 | 74 | 217 |
| 2024 Julio | 121 | 46 | 167 |
| 2024 Junio | 129 | 49 | 178 |
| 2024 Mayo | 109 | 56 | 165 |
| 2024 Abril | 89 | 32 | 121 |
| 2024 Marzo | 105 | 36 | 141 |
| 2024 Febrero | 76 | 35 | 111 |
| 2024 Enero | 81 | 41 | 122 |
| 2023 Diciembre | 78 | 31 | 109 |
| 2023 Noviembre | 78 | 43 | 121 |
| 2023 Octubre | 94 | 32 | 126 |
| 2023 Septiembre | 87 | 35 | 122 |
| 2023 Agosto | 58 | 28 | 86 |
| 2023 Julio | 71 | 45 | 116 |
| 2023 Junio | 68 | 22 | 90 |
| 2023 Mayo | 77 | 32 | 109 |
| 2023 Abril | 74 | 20 | 94 |
| 2023 Marzo | 72 | 36 | 108 |
| 2023 Febrero | 64 | 35 | 99 |
| 2023 Enero | 87 | 41 | 128 |
| 2022 Diciembre | 92 | 32 | 124 |
| 2022 Noviembre | 75 | 47 | 122 |
| 2022 Octubre | 74 | 36 | 110 |
| 2022 Septiembre | 64 | 63 | 127 |
| 2022 Agosto | 69 | 33 | 102 |
| 2022 Julio | 59 | 44 | 103 |
| 2022 Junio | 65 | 47 | 112 |
| 2022 Mayo | 57 | 48 | 105 |
| 2022 Abril | 67 | 55 | 122 |
| 2022 Marzo | 59 | 59 | 118 |
| 2022 Febrero | 45 | 43 | 88 |
| 2022 Enero | 56 | 60 | 116 |
| 2021 Diciembre | 43 | 52 | 95 |
| 2021 Noviembre | 54 | 51 | 105 |
| 2021 Octubre | 56 | 60 | 116 |
| 2021 Septiembre | 62 | 45 | 107 |
| 2021 Agosto | 51 | 41 | 92 |
| 2021 Julio | 65 | 45 | 110 |
| 2021 Junio | 53 | 35 | 88 |
| 2021 Mayo | 89 | 27 | 116 |
| 2021 Abril | 82 | 53 | 135 |
| 2021 Marzo | 75 | 29 | 104 |
| 2021 Febrero | 72 | 49 | 121 |
| 2021 Enero | 33 | 32 | 65 |
| 2020 Diciembre | 41 | 8 | 49 |
| 2020 Noviembre | 28 | 16 | 44 |
| 2020 Octubre | 24 | 11 | 35 |
| 2020 Septiembre | 26 | 8 | 34 |
| 2020 Agosto | 36 | 20 | 56 |
| 2020 Julio | 40 | 7 | 47 |
| 2020 Junio | 46 | 23 | 69 |
| 2020 Mayo | 33 | 13 | 46 |
| 2020 Abril | 33 | 11 | 44 |
| 2020 Marzo | 41 | 11 | 52 |
| 2020 Febrero | 3 | 2 | 5 |
| 2020 Enero | 4 | 4 | 8 |
| 2019 Diciembre | 8 | 0 | 8 |
| 2019 Noviembre | 4 | 2 | 6 |
| 2019 Octubre | 0 | 4 | 4 |
| 2019 Septiembre | 8 | 4 | 12 |
| 2019 Agosto | 2 | 2 | 4 |
| 2019 Julio | 6 | 2 | 8 |
| 2019 Junio | 6 | 17 | 23 |
| 2019 Mayo | 4 | 16 | 20 |
| 2019 Abril | 2 | 3 | 5 |
| 2019 Marzo | 2 | 7 | 9 |
| 2019 Febrero | 4 | 0 | 4 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 46 | 0 | 46 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 0 | 4 | 4 |
| 2018 Febrero | 34 | 5 | 39 |
| 2018 Enero | 47 | 12 | 59 |
| 2017 Diciembre | 62 | 17 | 79 |
| 2017 Noviembre | 90 | 9 | 99 |
| 2017 Octubre | 39 | 8 | 47 |
| 2017 Septiembre | 53 | 9 | 62 |
| 2017 Agosto | 100 | 10 | 110 |
| 2017 Julio | 68 | 14 | 82 |
| 2017 Junio | 89 | 32 | 121 |
| 2017 Mayo | 80 | 23 | 103 |
| 2017 Abril | 103 | 22 | 125 |
| 2017 Marzo | 58 | 8 | 66 |
| 2017 Febrero | 39 | 19 | 58 |
| 2017 Enero | 34 | 15 | 49 |
| 2016 Diciembre | 56 | 25 | 81 |
| 2016 Noviembre | 59 | 16 | 75 |
| 2016 Octubre | 81 | 18 | 99 |
| 2016 Septiembre | 78 | 14 | 92 |
| 2016 Agosto | 67 | 16 | 83 |
| 2016 Julio | 52 | 10 | 62 |
| 2016 Junio | 9 | 9 | 18 |
| 2016 Mayo | 9 | 15 | 24 |
| 2016 Abril | 5 | 21 | 26 |
| 2016 Marzo | 2 | 17 | 19 |
| 2016 Febrero | 10 | 1 | 11 |
| 2016 Enero | 4 | 1 | 5 |
| 2015 Diciembre | 5 | 2 | 7 |
| 2015 Noviembre | 2 | 4 | 6 |
| 2015 Octubre | 4 | 2 | 6 |
| 2015 Septiembre | 4 | 8 | 12 |
| 2015 Agosto | 3 | 1 | 4 |
| 2015 Julio | 38 | 1 | 39 |
| 2015 Junio | 36 | 8 | 44 |
| 2015 Mayo | 39 | 16 | 55 |
| 2015 Abril | 20 | 17 | 37 |
| 2015 Marzo | 26 | 12 | 38 |
| 2015 Febrero | 12 | 6 | 18 |
| 2015 Enero | 54 | 7 | 61 |
| 2014 Diciembre | 64 | 9 | 73 |
| 2014 Noviembre | 20 | 4 | 24 |
| 2014 Octubre | 25 | 4 | 29 |
| 2014 Septiembre | 14 | 2 | 16 |
| 2014 Agosto | 19 | 7 | 26 |
| 2014 Julio | 26 | 5 | 31 |
| 2014 Junio | 47 | 13 | 60 |
| 2014 Mayo | 101 | 9 | 110 |
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